Am I judgmental?
I had an unusual encounter in my office with a new patient. After introducing myself I asked how I could help her and then I asked her to tell her story. Her problem was complex and there were key pieces of the puzzle missing so I asked her my usual probing gyno questions. What have you tried? When was your last period? Could you be pregnant? What do you use for birth control? Do you use condoms to protect you from STDs? Do you have sex with men or women? Is there pain and at what level and duration, odor, discharge, fever, chills, nausea, vomiting, and etc, etc?????
Take a deep breathe and give me the facts ma’am.
Doctors call this information the HPI or history of the present
illness. What made the patient seek help today? I call it the patient’s story.
I do not call it the Inquisition!
Was it something I asked?
I feel bad about this particular visit because the patient left dissatisfied and frustrated. I could sense her anger during the first five minutes of the discussion so I asked her how I could better help her and she said, “You are judging me.” Wait, what just happened? I was blind sided by her comments so I spent days trying to unravel, actually obsessing, about this interaction. Her situation was complicated so I needed as many pieces of the puzzle as possible to help her. Unfortunately my probing questions felt judgmental to her even though I truly was not judging her.
Believe me; I know when I’m asking judgmental questions.
Just ask my sons about the Inquisitions they endured when I found out they were jumping into the river off of railroad bridges or doing any of the many idiotic things that boys do! Those conversations were full of judgments.
Doctors are just human.
We do occasionally judge our patients as much as we try not to, but usually not over the things patients think we are judging. For example; when you contract an STD or experience an unintended pregnancy, I empathize with you but I don’t judge you. If you no show, no call for your appointment, then I judge your irresponsible behavior or your defective smart phone calendar. If you’ve had multiple sexual partners I don’t judge. If you yell at my staff because you failed to plan and now need an emergency prescription refill, then I judge your lack of planning ability. (Every prescription tells you how many refills you have left so you have many opportunities to call for a refill before you take the last pill in your pack. So don’t shoot the messenger!)
It is my privilege to hear your story
My son, the newest Dr. Delaplain, once wrote, “Every patient has a story and it’s a physician’s job to hear it.” We don’t know your story until you tell it to us. I genuinely want to help but I need the facts. You can’t offend, gross out or shock a gynecologist. In 27 years of medicine, I have heard everything, so trust me with your secrets. My exam room is a sacred and safe place. My lips are sealed. Tell me everything even if you are scared, embarrassed, have regrets, think its trivial, or think I’m judging you.
The next time you go to the doctor take the time to write down a few notes.
When did the problem start? What is the intensity and duration? What makes it better or worse? What have you tried? Have you had it before and what helped? Bring your old records if possible.
Help me find the missing pieces; tell me your story and don’t leave out the good or the bad parts.